Patient-reported barriers and facilitators to antiretroviral adherence in sub-Saharan Africa

Abstract

Objective:The aim of this study was to identify the range and frequency of patient-reported barriers and facilitators to antiretroviral treatment (ART) adherence in sub-Saharan Africa (SSA).Design:Studies from 2005 to 2016 were identified by searching 10 electronic databases and through additional hand and web-searching.Methods:Inclusion criteria were HIV-positive adults taking ART based in any SSA country, qualitative study or quantitative survey and included at least one patient-reported barrier or facilitator to ART adherence. Exclusion criteria were only including data from treatment-naive patients initiating ART, only single-dose treatment, participants residing outside of SSA and reviews.Results:After screening 11 283 records, 154 studies (161 papers) were included in this review. Forty-three barriers and 30 facilitators were reported across 24 SSA countries. The most frequently identified barriers across studies were forgetting (n = 76), lack of access to adequate food (n = 72), stigma and discrimination (n = 68), side effects (n = 67) and being outside the house or travelling (n = 60). The most frequently identified facilitators across studies were social support (n = 60), reminders (n = 55), feeling better or healthier after taking ART (n = 35), disclosing their HIV status (n = 26) and having a good relationship with a health provider (n = 22).Conclusion:This review addresses the gap in knowledge by collating all the patient-reported barriers and facilitators to ART adherence in SSA. Current barriers measures need to be adapted or new tools developed to include the wide variety of factors identified. The factors that have the greatest impact need to be isolated so interventions are developed that reduce the barriers and enhance the facilitators.

Perceptions and decision-making with regard to pregnancy among HIV positive women in rural Maputo Province, Mozambique – a qualitative study

“…This study echoes many of the findings in the above countries which revealed how low adherence to antiretroviral therapy was related to several other significant factors: fear of HIV disclosure [50, 51]; stigma and discrimination; side effects of antiretroviral drugs [49, 52]; transportation costs; and long waiting periods at health facilities to obtain antiretroviral drugs [48, 53, 54]. A further factor was the inadequate use of modern contraceptives.…”

Qualitative exploration of perceived benefits of care and barriers influencing HIV care in trans Nzoia, Kenya

“…Individual factors frequently cited include stigma or fear of disclosure [2,[5][6][7][8], limited knowledge about HIV and its care [7,[9][10][11], concurrent disease, (especially drug abuse) [5,7,11,12], and inadequate financial support [2, 5-7, 11, 13]. Religious and cultural beliefs [5,7,9,13], negative side effects of drugs [2,[5][6][7]11], lack of motivation to adhere to treatment [5,11,14], insufficient food support [5,11,15], work demands [5,7,[11][12][13], and lack of insurance [12,16] have also been cited as significant challenges to individual HIV care [9,12]. Community obstacles include social prompting towards herbal and alternative care, limited social support [5,7,11] and unreliable or non-existent transportation [5,12].…”

“…Religious and cultural beliefs [5,7,9,13], negative side effects of drugs [2,[5][6][7]11], lack of motivation to adhere to treatment [5,11,14], insufficient food support [5,11,15], work demands [5,7,[11][12][13], and lack of insurance [12,16] have also been cited as significant challenges to individual HIV care [9,12]. Community obstacles include social prompting towards herbal and alternative care, limited social support [5,7,11] and unreliable or non-existent transportation [5,12]. Health systems barriers in initiating and maintaining care compound these individual and community barriers to HIV care.…”

“…Health system barriers consist of structural, process, and relational issues. Shortages in healthcare personnel [12,14,17], long distance to health facilities [4,11,15,18] and poor interactions with patients are commonly reported barriers to HIV care [5,11,12,14]. Other health systems barriers have included frequent appointments [11,19,20], unfriendly health staff with a breakdown of patient-provider trust [5,7,11,14], and poor reimbursement for services by government and other financial support programs [9,14,16,17].…”

Factors for incomplete adherence to antiretroviral therapy including drug refill and clinic visits among older adults living with human immunodeficiency virus – cross‐sectional study in South Africa

“…Suboptimal adherence can be due to individual, service, socio-economic and cultural factors [11][12][13][14][15][16]. Several recent systematic reviews found that suboptimal adherence to ART is associated with a range of individual, interpersonal, community and structural factors, including stigma and discrimination, forgetting, alcohol/ substance misuse, dissatisfaction/distance to healthcare facility and depression [17][18][19].…”